Review of Psychotrophic Medications

(An approved North Carolina Division of Health Services Regulation Continuing Education Course)

Common Psychiatric Disorders *Schizophrenia *Depression *Bipolar Disorder *Anxiety *Attention Deficit Hyperactivity Disorder

General Notes on Psychiatric Treatment

*Medications treat symptoms, not cure disorder *Medications work differently for different people *Side Effects can differ based on the following:

-type of medication -liver/kidney function -sex of patient -genetics -body size -other treatments -physical illness -diet -lifestyle habits -dose of

medication

General Notes Continued….. *Monitoring signs/symptoms every 2 weeks and reassess response at 4-8 weeks & if… -clear response: continue treatment 4-8 weeks until symptoms in remission -partial response: (no side effects) - increase dose and reassess in 4 weeks -no response: (or side effects too great) - change medication to different class,

and reassess in 4-8 weeks

Goal of Remission: no symptoms for 2-6 months

General Notes Continued….. *Treatment Duration

-No one should stop medications abruptly -Acute treatment phase: 6-12 weeks - goal is to decrease symptoms &

find dose that works

-Continuation phase: 6-9 months -Maintenance Therapy considered if: *History of 3+ episodes *Severe Episodes *Psychotic features (hear/see things) *Pt with chronic depression 2-5 years

Schizophrenia

Schizophrenia is a mental disorder that makes it hard to: Tell the difference between what is real and not real; Think clearly; Have normal emotional responses; Act normally in social situations. Treatment with Typical or Atypical Antipsychotics

Schizophrenia Treatment (Typical Antipsychotics)

Brand Generic

Thorazine Chlorpromazine

Haldol Haloperidol

Trilafon Perphenazine

Prolixin Fluphenazine

Clozaril Clozapine

Schizophrenia Treatment (Atypical Antipsychotics)

Brand Generic

Risperdal Risperidone

Zyprexa Olanzapine

Seroquel Quetiapine

Geodon Ziprasidone

Abilify Aripiprazole

Invega Paliperidone

Saphris Asenapine

Latuda Lurasidone

Schizophrenia Treatment Side Effects Typical: physical movement changes varying from tremors and spasms to more severe tardive dyskinesia and pseudoparkinsonism. (involuntary movements) Atypical: Weight gain Both Types: drowsiness, dizziness, blurry vision, rapid heartbeat, sensitivity to sunlight, skin rashes, and menstrual problems in women Clozaril: agranulocytosis (WBC loss)

Schizophrenia Treatment Patient Information

*Takes up to 4-6 weeks to see optimum effects *May be sensitive to weather changes due to decrease in sweat production. *Clozapine - WBC checked on a routine basis

Depression

Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods.

Depression Treatment (4 Classes) 1.SSRI - Selective serotonin reuptake inhibitors 2.SNRI - Serotonin-norepinephrine reuptake inhibitors 3.TCA - Tricyclic antidepressants 4.Others

Depression Treatment - SSRI

Brand Generic

Prozac Fluoxetine

Celexa Citalopram

Lexapro Escitalopram

Zoloft Sertraline

Paxil Paroxetine

Depression Treatment - SNRI

Brand Generic

Effexor Venlafaxine

Cymbalta Duloxetine

Pristiq Desvenlafaxine

Depression Treatment - TCA

Brand Generic

Elavil Amitriptyline

Tofranil Imipramine

Sinequan Doxepin

Pamelor Nortriptyline

Depression Treatment - Others

Brand Generic

Remeron Mirtazapine

Desyrel Trazodone

Wellbutrin Bupropion

Depression Treatment - Side Effects Nausea: Bupropion, Mirtazapine, SNRI’s, SSRI’s Agitation: Bupropion, Mirtazapine, SSRI’s Fatigue/Sedation: Bupropion, Mirtazapine, Trazodone, SSRI’s, TCA’s Sexual Dysfunction: SSRI’s, TCA’s, SNRI’s Weight Gain: Bupropion, Mirtazapine, SSRI’s, TCA’s Anticholinergic effects: Bupropion, Mirtazapine, SSRI’s, SNRI’s Hypotension: TCA’s

Depression Treatment - Patient Information

*Reassure Depression is a common condition and can be successfully treated *Consider drug interactions with other treatment, that can cause increased

serotonin and/or dopamine, such as the following: -Clonidine -Birth Control -Beta Blockers -High-dose Steroids -Alcohol -CNS Depressants

Bipolar Disorder

Bipolar disorder is a condition in which a person has periods of depression and periods of being extremely happy or being cross or irritable.

Bipolar Disorder Treatment Mood Stabilizers (or anticonvulsants) alone or in combination with antidepressants)

Brand Generic

Mood Stabilizers Eskalith Lithium Carbonate

AntiConvulsants Depakote Divalproex

Tegretol Carbamazepine

Lamictal Lamotrigine

Trileptal Oxcarbazepine

Bipolar Treatment Common Side Effects

Lithium: loss of coordination, excessive thirst, frequent urination, hallucinations, vision changes, edema

Anticonvulsants: weight gain, dizziness, drowsiness, nausea

Divalproex: females can develop polycystic ovarian syndrome

Lamotrigine: skin rash that can be very severe

Bipolar Treatment - Patient Information

*No cure of Bipolar Disorder, treatment is available and can be successful

*Regular monitoring of drug levels, thyroid level, liver and kidney function is recommended

*Keep regular visits with physicians for side effects monitoring & dose escalations or changes

*Have close family member or friend to help monitor on a daily to weekly basis

Anxiety Disorder

Stress can come from any event or thought that makes you feel frustrated, angry, or nervous. Anxiety is a feeling of fear, unease, and worry. The source of these symptoms is not always known.

Anxiety Disorder Treatment (Benzodiazepines)

Brand Generic

Klonopin Clonazepam

Ativan Lorazepam

Xanax Alprazolam

Valium Diazepam

Librium Chlordiazepoxide

Serax Oxazepam

Benzodiazepine Side Effects

Blurred Vision Upset Stomach

Headache Drowsiness Confusion

Anxiety Disorder - Patient Information

*Buspirone (Buspar) is an alternative option. Has less sedative side effects.

*Beta-Blockers (Propranolol) also an option *High chance of dependence with Benzodiazepines,

therefore these medications should be tapered down instead of being stopped abruptly

Attention-Deficit/Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is a problem of not being able to focus, being overactive, not being able control behavior, or a combination of these. For these problems to be diagnosed as ADHD, they must be out of the normal range for a person's age and development.

ADHD Treatment

Brand Generic

Methylphenidates Ritalin, Methylin Methylphenidate

Metadate ER, Ritalin SR, Methylin ER

Methylphenidate

Focalin Dexamethylphenidate

Concerta, Metadate CD, Ritalin LA, Daytrana

Methylphenidate

Amphetamines Dexadrine Dextroamphetamine

Vyvanse Lisdexampetamine

Adderall Dextramphetamine / Amphetamine

ADHD Treatment Side Effects *Decreased appetite *Insomnia *Abdominal pain *Headaches *Tics *Cardiac Issues

ADHD - Patient Information *Strattera (Atomoxetine) - also approved for ADHD, but has an increased risk of suicide in children *Long-acting should be taken in the morning to prevent lack of sleep/insomnia *Determine if only needed during school/work or all the time